颅脑创伤去骨瓣减压术后低颅压脑积水

Clinical analysis of low pressure hydrocephalus after decompressive craniectomy in patients with traumatic brain injury

目的探讨颅脑创伤患者去骨瓣减压术后低颅压脑积水(LPH)的发病机制、诊断及治疗。方法选择晋中市第一人民医院神经外科自2012年10月至2020年5月收治的6例去骨瓣减压术后LPH患者,均采用可调压非抗虹吸分流管行脑室-腹腔分流术。4例患者二期行颅骨缺损钛网成形术,2例患者同期行颅骨缺损钛网成形术。于术前及术后1周、1个月、3个月统计患者认知功能、步态、尿便功能,采用头部螺旋CT影像学检查,评价手术效果。结果6例患者术后均未发生严重并发症。脑室-腹腔分流术后1周~2个月患者症状明显改善,且脑室系统明显回缩。分期行脑室-腹腔分流与钛网成形术,术后患者症状及影像学检查表现改善较快。结论可调压非抗虹吸分流管行脑室-腹腔分流术是治疗去骨瓣减压术后LPH的有效方法,并且在二期行钛网成形术的治疗效果可能更佳。

Objective To investigate the pathogenesis,diagnosis and treatment of low pressure hydrocephalus(LPH)after decompressive craniectomy in patients with traumatic brain injury.Methods The authors retrospectively analyzed 6 patients who underwent ventriculoperitoneal shunt without anti-siphon device for treatment of LPH after decompressive craniectomy between October 2012 and May 2020 in the neurosurgery department of The First People’s Hospital of Jinzhong.Cranioplasty was undergone in 2 cases with titanium mesh implant in the meantime.To evaluate the effect of surgery,the cognitive function,gait,urine and stool function,and spiral CT imaging of the head were analyzed before operation and 1 week,1 month and 3 months after operation.Results None of the 6 patients had serious complications after surgery.One week to two months after ventriculoperitoneal shunt,the patients’symptoms improved significantly,and the ventricular system retracted significantly.Ventriculoperitoneal shunt and titanium mesh plasty were performed in stages,and the symptoms and imaging findings of patients improved rapidly after surgery.Conclusion Ventriculoperitoneal shunting with adjustable pressure without anti-siphon device were an effective method for LPH after decompressive craniectomy in patients with traumatic brain injury,and the treatment may be more effective to underwent cranioplasty with titanium mesh implant in the next stage.